General Session

TSDA General Session in Conjunction with the Annual STS Meeting
January 30, 31 and February 1, 2003
Hyatt San Diego
San Diego, CA

Summary:

Synopsis of TSDA-STS Meeting
February 3, 2003
San Diego, California

The Thoracic Surgery Directors Association had an excellent meeting in San Diego in conjunction with the annual STS meeting. The first hour of the program was dedicated to continuing the discussion on work hours in thoracic surgery. I reviewed the current ACGME guidelines and summarized our previous meeting at the ACS in September concerning the potential impact on cardiothoracic training. We then presented a list of concrete suggestions that had been submitted by the constituency of the TSDA to deal with this ACGME issue (see last page). As all of you know, we must have a resolution of this process by July of 2003. We also had Dr. Dearani from the Mayo Clinic and Dr. Sellke from Beth Israel in Boston give concrete examples of how they have addressed these issues within their own programs. In the distributed white program binder there were other examples from the University of Michigan, the University of Washington, and Northwestern University. Also in the white binder were all current references concerning work hour issues that may help a program director deal with this transition.

The next hour and a half of the program was directed towards curriculum reform and what would a program director need to consider if they wanted to change the length or structure of their training program. I gave an introduction on the historical foundations leading to a widespread belief that thoracic surgery must develop new options to deal with curricular reform. Much of the foundation work came out of the Joint Council on Thoracic Surgery Education under the leadership of Fred Crawford. That Council recommended nine potential reform issues including making ABTS certification optional for ABS training. Once this issue was accepted by the various thoracic surgery councils (ABTS, RRC, TSDA, etc.), the door opened to considering 1) integrated programs where applicants would be matched out of medical school or 2) shorter curricular options involving an abbreviated General Surgery foundation and an extended Thoracic Surgery Curriculum.

Dr. Mathisen presented the perspective of the RRC in terms of what type of standards and regulations may occur. Drs. Kron and Gay provided excellent insights into the perspectives of the American Board of Surgery and the American Board of Thoracic Surgery. Currently vascular surgery and pediatric surgery have developed a potential 4-3 option, both leading to board certification in general surgery after 4 years of foundation and 2 or 3 years of sub-specialty training. Thoracic surgery was not initially included in that list because they have a separate Board. Subsequently plans were made for three representatives of the American Board of Surgery (Malangoni, Lewis, Maier) to meet with four representatives of thoracic surgery (Gay, Kron, Gardner, and Pairolero) to discuss whether a similar option would be available in thoracic surgery. This is an important discussion because it would also allow a 4-3 curriculum in Thoracic Surgery. A three-year TS curriculum was recommended by the Joint Council as optimal for thoracic surgery education.

We then gave two examples of how to either change a two-year training program in thoracic surgery to a three-year duration. This was presented by myself as we recently went through this process at the University of Washington. Those slides are available to other Program Directors by request. In addition, Dr. Jeff Gold went through the process of developing a six-year integrated program out of medical school using the foundation work which was previously developed for much of the discussions at the ABTS and RRC levels. Those discussions were well received. There is additional data in the white binder that hopefully will allow programs to deal with curricular reform within their programs if they so choose.

The second half of the meeting dealt with new and old business. The Thoracic Surgery Research Award presentation was given to Frederick A. Tibayan from Stanford University for his presentation entitled: “A Geometric Remodeling in Chronic Ischemic Mitral Regurgitation.” His Program Director, who also received an award, was Dr. Bruce Reitz. Dr. Richard Lee, President of the Thoracic Surgery Residents Association, then presented the TSRA Socrate Award to Dr. William Baumgartner as an example of an outstanding thoracic surgical educator.

Dr. Verrier’s Presidential report was brief and emphasized the following objectives: 1) to expand and improve the current curriculum on-line, 2) to improve the Thoracic Surgery Directors website, 3) to enhance and improve the competency evaluation tool for residents and faculty, 4) to continue to be a resource for curricular reform, 5) to continue to be a resource for work hour issues for Program Directors, 6) to continue to obtain financial support for our curriculum development, 7) to continue to be a resource in thoracic surgery leadership to the AAPD, TS RRC, the ABS, and the ABTS, and 8) to work hard to continue to attract the best and brightest applicants to cardiothoracic surgery.

Dr. Gold then presented the Secretary-Treasurer’s report. Dr. Gold was pleased to re- confirm the commitment of support for our curricular efforts from both Edwards and Ethicon through 2003. This is the second year in a proposed five-year program from Ethicon. Dr. Gold noted that the Edwards Company has a keen interest in the educational product having recognized the value of its accountability. Dr. Gold underscored that there may be challenges in the future with call for support which could make financing of programs more tentative. Overall, his presentation of our current financial profile showed a robust reserve compared to five years ago and an opportunity to continue our curricular efforts. He did note that some other discussions would be necessary in order to look carefully at the dues structure, sources of other income such as charging fees for meeting attendance, dues and fees for coordinators, meeting registration fees, a charge for information or material, marketing of the curriculum, and charges for the Blue Book. All of these possibilities were further discussed at the Executive Committee Meeting and will be re-presented to the constituency in May.

The Nominating Committee of the organization was completed. Dr. Verrier nominated Irv Kron as his representative to the Committee and the constituency elected Bruce Reitz as their elected member. Nominations are necessary for President-Elect, for Secretary- Treasurer, and for Councilor. The transition in organizational leadership will occur in Boston during the TSDA-AATS meeting.

We then had some brief updates on our major projects. The Evaluation Tool developed by Bill Begg was distributed in September and is being used by a number of programs. We believe this evaluation tool can be upgraded by making data entry easier (electronic), and the evaluations more comprehensive. This upgrade is in process and will be completed by the May meeting. The Evaluation Tool was also distributed to other programs who had not previously received it.

Dr. Gold gave an update on the Pre-Requisite Curriculum Committee. As you know, he has submitted an abstract based on the assessment of this pre-requisite curriculum tool efficacy. The study group has been able to show that the curriculum had a positive effect on ABSITE scores based on use prior to entering the cardiothoracic training program. This data will hopefully be put into a manuscript form for submission to one of our journals. Dr. Gold is also planning to re-convene the Pre-Requisite Curriculum Committee to update the tool for future years.

Dr. Calhoon gave a brief review of the survey sent to regionalize resident interviews. This is a complex question. Clearly, most residents are spending upwards to $5,000 traveling around the country for interviews. There is a belief that this process could be simplified, potentially regionalized, and the form approved. Dr. Calhoon has attempted to coordinate his interview time slots to correspond favorably with time slots offered by programs in Dallas and Houston for the benefit of the interviewer. This could be done by other geographically close programs. He will review the results of that effort and update on the survey over the next few months.

Dr. Shemin and Bill Begg then reported on the Curriculum Implementation Committee. Over 100 pieces of programming have been harvested and are presently being formatted to place on the Thoracic Surgery Directors Association website. The process of placing such educational information on the Website includes putting the video in a Power-point presentation format, dictating an audio complement to the video, sending the combined audio and video presentation to Bill Bell who will submit the completed material to Amadeus for formatting for presentation on our TSDA website. This is another project which hopefully will continue to yield fruit over the next few months. We are hoping that at least 100 pieces of information will be placed on the TSDA website by April and the rest of the Requisite Curriculum will be filled out by other presentations.

Dr. Richard Shemin gave a brief report on the status of the National Match lawsuit. This is a lawsuit submitted by a few residents around the country basically claiming an anti- trust issue with the current National Match program. This has tremendous long-term implications on how residents are chosen (chaos). A number of educational societies are the defendants and are accumulating information, dollars, and support for defending this lawsuit. Dr. Shemin will continue to update the TSDA constituency due to his representation on the Council of Academic Specialties and the Council on Medical Specialty Societies.

Overall, the San Diego meeting was comprehensive and dealt with a number of critical issues to the organization and to the Program Directors. The Executive Committee was very pleased with the excellent turnout and the lively discussions.

Propose Program for TSDA Meeting
Thursday January 30, 2003
San Diego Hyatt Hotel
San Diego, CA
8:00 AM – 12:00 PM Regency D Ballroom

1. WELCOME
   
2. Formal TSDA Program: “Work Hour Issues In Thoracic Surgery (8:00AM – 9:00AM)
   1. Ed Verrier, MD moderator
      1. EDV: New ACGME Guidelines, Potential Impact on Cardiothoracic Training
         1. Synopsis of San Francisco meeting presentations
         2. Concrete recommendations for change
      2. Douglas Mathiesen, MD (Chair, Thoracic Surgery RRC “Report of September ACGME Retreat”; Report of January RRC meeting
      3. Thoracic Surgery Program Examples:
         1. Presentations to be decided
         2. 10 written examples in handout binder
            
3. Curricular Reform (9:00Am – 10:30AM):
   1. Introductory Presentation Ed Verrier: “What will I have to do if I want to go to a 3 year CT program, or start an Integrated Program, or coordinate a Core(4/3 or 3/3) program with General Surgery”
      1. Background / Historical Perspective
   2. Mathiesen: Perspective of the RRC
      1. New RRC regulations / suggestions in binder
   3. Irv Kron: Perspective of ABS
      1. ABS handout in binder
   4. William Gay: Perspective of ABTS
      
4. Example of RRC proposals:
   1. Going from 2 year to a 3 year program (Verrier)
   2. Developing an Integrated curriculum (Gold)

   Refreshment Break (10:30 – 10::45AM)

5. New and Old Business (10:45AM – 12:00 noon)
   
6. TSDA Resident Research Award Presentation (Edward Verrier,MD)
   
7. TRSA Socrates Award Presentation (Richard Lee, MD)
   
8. Business meeting
   1. Presidential report
   2. Secretary / Treasurer reports:
   3. Nominating committee
      1. Need to vote on one representative from the floor
      2. President to announce his appointment to committee
         
9. Evaluations / Competency:
   1. Update on Use and Efficacy of Evaluation tool
      1. Bill Begg
   2. Distribution of Evaluation tool to all program directors who have not previously received the tool
      
10. RRC requests for new or expanded programs (Mathisen Appointee)
    
11. Report of Pre- requisite Curriculum Committee (Jeff Gold,MD)
    1. Update of Prerequisite Curriculum
    2. Status of publication plans
       
12. Report on survey to regionalize resident interviews: (John Calhoon, MD)
    
13. Report of Curriculum Implementation Committee (Shemin / Begg)
    1. Where we stand and where we are headed with Requisite Curriculum
       
14. Brief report on the status of the National Match Lawsuit: (Richard Shemin, MD)
    
15. Update on the status of the TSDA Web-site (Bill Begg)
    
16. Announce plans for AATS / TSDA meeting May 2003

All Meeting Sessions:

Content (from slide presentations):

Work Hours Issues in Thoracic Surgery
  Edward Verrier, MD
 
Curriculur Reform: Change is in the Wind
  Edward Verrier, MD
 
Perspective of the ABS
  Irv Kron, MD
 
Developing an Integrated Curriculum
  Jeffrey P. Gold, MD
 
Report on Regionalized Interviews Survey
  John Calhoon, MD